Session Item

Recent epidemiologic trends highlighted a rising incidence of Human Papilloma Virus (HPV) related oropharyngeal squamous cell carcinoma (OPC) in the older population, with projected increase of over 50% in subjects older than 65 years in the next decade. Patients (pts) older than 75 years are considered as “late” elderly. Being largely underrepresented in clinical trials, there is a paucity of data on their disease trajectory. The aim of our work was to assess the pattern of practice in this specific subgroup of pts within the Italian Association of Radiotherapy and Clinical Oncology (AIRO).

This is an observational, retrospective study focused on a 6-year timeframe (2015-2021).  Consecutive patients aged >75 years at diagnosis with a histologically-confirmed HPV positive (per p16 immunohistochemistry/HPV DNA-in situ hybridization) OPC deemed amenable to a curatively-intended treatment could be included.   Overall survival (OS) was defined as the time from OPC diagnosis to last follow-up or death from any cause. Median OS was estimated by the Kaplan-Meyer method. A log-rank test was employed to test whether smoking history, presence of caregiver, employed treatment modality and age (< or > 80 years) correlated with longer OS. Hazard ratios (HR) for the association between the variables of interest and the risk of death were obtained by univariate Cox regression analysis. A p-value <0.05 was considered statistically significant. Acute toxicity was evaluated according to CTCAE v. 5.0

A total of 95 patients were included in our study, with a median age of 78 years (table 1). The vast majority had a PS of 0-1 (92.6%), and a locally advanced disease (89.4% in stage III/IV according to TNM 7th edition). As expected, radiotherapy alone was the most common adopted modality. At a median follow-up of 25 months (range: 0-116), 64 patients were alive (67.3%). The one and two-year OS rates were 83% and 75%, respectively, whereas the median OS was not reached (figure 1). Among the tested variables, belonging to the group of age >80 years was associated with a worse OS (p=0.0429; HR for death, 2.15, 95% CI 1.00-4.60), whereas no impact on survival was associated with the smoking history (p=.011), treatment modality (p=0.32) and presence of caregiver (p=0.65). The toxicity profile was acceptable (>G3 toxicity of 29.4%), although 6 patients (6.3%) died due to treatment-related complications. Further analyses on radiation dose, target volumes and pattern of failure will be reported

To the best of our knowledge, our study represents one of the largest series to date on “late” elderly patients with non-metastatic HPV positive OPC treated with a curatively-intended, radiation-based approach. In a carefully selected population, an optimal survival outcome was achieved with standard treatment options, in line with what is usually reported in their younger counterparts. Prospective studies in larger cohorts of geriatric pts are warranted in order to confirm our findings